Cancer’s aftermath

New clinic focuses on care for survivors

Nurse practitioner Kelly Bugos, RN, (right) and Holly Gautier, RN, are helping to coordinate patient care and research programs in the new Stanford Survivorship Clinic.

Janelle O’Malley has been cancer-free for eight years, following a complete hysterectomy to remove a malignant tumor. The aftermath of that surgery defines her as one of more than 12 million Americans who have had cancer. As those numbers rise, the lingering effects of the disease are fueling a new dimension of treatment—care for cancer survivors.

In February, O’Malley became a patient in the new Stanford Survivorship Clinic, one of a small but growing number of clinics nationwide where care is focused on wellness after cancer treatment.

“Our health-care system is much more geared to acute rather than chronic care, and we haven’t established a good transition back to routine care,” said David Spiegel, MD, director of Stanford’s Center for Integrative Medicine and a long-time researcher on the interaction between the psychosocial and physiological impact of cancer. “People develop significant issues after cancer—the question becomes how to live with this for the rest of your life. We want to develop a program to provide emotional and medical support for people who are beyond acute care. Survivorship care should be there from day one.”

Follow-up concerns

“There’s a whole body of knowledge and, more importantly, a whole collection of needs that cancer survivors have,” said Douglas Blayney, MD, medical director of the Clinical Cancer Center, where the new clinic is located. “Some are common across tumor types and some are unique to specific tumors. We are trying to meet those needs and serve those patients.”

Care at the new clinic will focus on issues common to most cancer survivors: fatigue, anxiety, body image, sexual function and relationships. Patients first will be seen by a nurse practitioner they likely met during treatment, said nurse practitioner Kelly Bugos, RN, a clinic founder. Should a concern arise beyond those issues, patients will be seen quickly by an appropriate physician.
Initially care will focus on patients like O’Malley, who have had gynecologic cancers. “We’ve set this up so we will be seeing patients we’ve been following for quite a while, with the expectation that they are cured or have a chance for a long-term remission,” said Jonathan Berek, MD, director of the Stanford Women’s Cancer Center and an internationally known clinician and researcher in gynecologic cancers. “The focus will be on issues important to them: health maintenance, screening for other cancers and the psychological and physical adaptations for someone who has gone through the trauma of being diagnosed and treated with a life-threatening disease.”

Such patients don’t need to be seen by their oncologists, Berek said. “This is an adjunct that maximizes the quality of their care. They’ll have someone who can spend more time with them, go over tests, get them involved in support groups and pay more attention to those needs not related to a cancer recurrence.”

Stanford’s Survivorship Clinic was developed after a year of study, site visits and discussions, including some with experts from the LIVESTRONG Survivorship Centers for Excellence. Established in 2005, the network collaborates with institutions like Stanford to create nationally recognized standards and metrics of care.

On the first visit to the survivorship clinic, patients and their caregivers will work together to develop a treatment plan. “Being diagnosed with cancer can make you feel out of control, but once you have a treatment plan, you can follow that plan,” Bugos said. “Once that treatment plan is done, you can feel out of control again, so having a survivorship plan is important.”

Ongoing research

The clinic will draw on some existing resources, including Spiegel’s decades of work on the psychosocial aspects of the cancer experience. He was among the first to show that being part of a cancer patient support group can have a significant impact on quality of life during treatment. Now he is working with Oxana Palesh, PhD, MPH, and other Stanford colleagues on research into the treatment of sleep disturbance, which occurs in 80 percent of cancer patients.

Shelli Kesler, PhD, another collaborator in Spiegel’s group, is looking at cognitive dysfunction related to chemotherapy, sometimes called “chemo brain” or cognitive fog. Researchers also are focusing on methods to treat the anxiety that can persist even after a patient is found to be cancer-free.

“The science of survival is very new—we haven’t done a lot of research—but we now have that luxury,” Bugos said. “We plan to become a program that offers the latest and best evidence-based interventions for our patients.”

As for O’Malley, “My path toward healing continues,” she said. “Once you have cancer, it embodies your spirit, your family, your friends and your future. I am extremely thankful that I am a part of the new Survivorship Clinic.”

For more information, contact the Stanford Survivorship Clinic at 650-498-6004.